About 80,000 people across Florida received letters Sept. 1 informing them their healthcare could be disrupted.
On that day, UF Health and UnitedHealthcare failed to solve months-long negotiations over pay rates, claims processes and administrative demands. To end the dispute without impacting patients, the two entities needed to come to an agreement before their contract’s scheduled renewal on the first of the month.
UF Health has set up a command center to field questions about the changes and is holding daily update meetings for Medicaid providers, Marvin Dewar, the CEO of UF Health Physicians, said in an interview with The Alligator.
“We would rather put all that energy into taking care of some patients,” Dewar said, “but right now we’re spending all this energy on this United contract.”
Patients with Medicaid and employer-sponsored commercial plans are now out-of-network at UF Health locations statewide. Medicare holders are not affected except at UF Health Flagler Hospital. UF students who hold United insurance through the Student Resources plan are also not affected, according to the university.
UF Health Central Florida locations and the UF Health Psychiatric Hospital are also unimpacted.
United did not respond to an interview request but said in a press release Sept. 1 that it is now focusing on helping Floridians transition to other providers or apply for continuity of care.
Students ‘shouldn’t see any change’
UF requires all degree-seeking students to buy a United student insurance plan if they are enrolled in at least six credit hours for undergraduate and five for graduate programs unless they can prove they already have comparable coverage.
The 5,000 to 7,000 students covered under this Student Resources plan will not see a change in care following the dispute, the university said.
United’s contract with UF Health is different from its contract with UF Student Affairs. The latter organizes student care similarly to a commercial employer, rather than a health entity. This allowed the university to create an accommodation so students didn’t get “caught in the middle” of negotiations, Dewar said.
In its own release, United said students could be out-of-network or experience higher rates. Dewar said the discrepancy arose because UF, not the insurance company, built the student exception. United did not respond to The Alligator’s request for clarification.
Students who have United through their parents rather than through the university, however, will be out-of-network for all UF Health locations except the on-campus Student Health Care Center.
Grace Russo, a 19-year-old UF microbiology sophomore, falls into that category. She visited the center in the week following the contract dispute to get a boot on her foot for an injury sustained while rowing for the university’s club crew team.
When the university rejected Russo’s insurance waiver last week, she talked to her parents, who told her they’d been receiving letters about the dispute for a few weeks, she said. But by the next day, the health network switched her application to “approved.”
Russo said no longer having access to other UF Health locations doesn’t affect her because she would only visit the on-campus center anyway.
“I didn’t have any issues, because I barely knew the issue was happening,” she said.
In an emergency, any hospital will treat people regardless of insurance. Patients cannot be charged more for getting emergency room services than at an out-of-network hospital under the Emergency Medical Treatment and Active Labor Act. This does not extend to visiting an ER or urgent care for non-emergency issues.
Medicaid and employer-sponsored plans out-of-network
All Medicaid holders are now out-of-network at all UF Health locations, except those in Central Florida. The negotiations disrupted care for 30,000 people on Medicaid, according to United.
In July, Stacye Sizemore, 35, scheduled a November consultation with a UF Health physician for a cyst removal procedure. Sizemore was confused at the end of August when she received a call from UF Health canceling her appointment because she would no longer be in the network.
She called United and an aide scheduled a new consultation within a week, she said. Sizemore was happy with how quickly the insurance company handled her case but said she wished she could remain in network with the UF Urgent Care in her neighborhood.
“I understand things cost money, but at what point do both of them say the patient is more important?” she said.
United doesn’t have any Gainesville providers in some specialty care fields, like pediatric lung doctors, said UF Health CEO Dewar, who has been involved in negotiations since they began several months ago.
The insurance company is required by law to have a sufficient network to provide care for Medicaid patients, Dewar said. Without UF Health providers, United must come up with alternatives to offer these people. In some cases, Dewar said, these alternatives don’t exist.
UF Health has decided to continue seeing some Medicaid patients despite being out-of-network if no other provider in the area offers the specialties they need, Dewar said. The health network will continue to bill United for these services, risking not getting reimbursed, he said.
“We’re not going to leave the Medicaid population just to fend for themselves,” he said.
People with employer-sponsored commercial plans are also now out-of-network for all non-Central Florida UF Health locations. These patients can apply for continuity of care, allowing them to remain temporarily in-network if they need health services like pregnancy care or cancer treatment.
People with Medicare plans will remain in-network at all locations except UF Health Flagler Hospital.
UF Health acquired Flagler in 2023 to become part of the new UF Health St. Johns medical network. Neither the health network nor the insurance company explained why only patients at this location can’t continue using Medicare.
Reasons for dispute and next steps
United said in a press release posted Sept. 1 that UF Health demanded a 30% price hike over two years, including a more than 20% rate increase in the first year of the contract.
“We need UF Health to approach the negotiating table with a realistic proposal Floridians can afford,” the release said.
UF Health CEO Dewar said United has not increased its payment rates in the past 10 years despite rising costs for wages and services. But more troubling than United’s payment rates are its denial rates. United denies payment for care at twice the rate of the health insurance average, he said.
Medicare users filed a class action lawsuit in 2023 accusing United of using an algorithm with a 90% error rate to deny payment to sick or injured patients. Other health networks, including HealthPartners in Minneapolis, have left United’s network in the past year due to denial rate concerns.
“It is kind of rich when United tries to stand on the platform of keeping healthcare costs down,” Dewar said.
United wrote in its release its proposals ensured UF Health would be reimbursed at rates similar to peers in the market. Demands from UF Health would mean employers could see costs increase in the next year, leaving them less money available to help grow businesses, United wrote.
Under UF Health’s proposal, consumers would end up paying more for hospital services like C-sections, pacemakers and emergency room visits, the release said.
Both UF Health and United have indicated a willingness to continue negotiating while encouraging patients to look into other provider options or apply for continuity of care in the meantime.
Contact Zoey Thomas at zthomas@alligator.org. Follow her on X @zoeythomas39
Zoey Thomas is a media production junior and the Fall 2024 Enterprise Health Reporter for The Alligator. She previously worked on the University and Metro desks. Her most prized assets include her espresso machine, Regal Unlimited movie pass and HOKA running shoes.
